eating disorders REVISE Flashcards
are eating disorders historical or a relatively new phenomenon?
occured in the past but categorised as other issues:
- renaissance - dying of a broken heart
- taking religious orders of only bread and water or just water
- first case of western eating disorder was a male
what are the 4 (potentially 5) types of eating disorders?
according to DSM5: Anorexia Nervosa (AN)
Bulimia Nervosa (BN)
Eating Disorder Not Otherwise Specified (EDNOS) but now Other Specificied Feeding and Eating Disorder
Binge Eating Disorder (linked to normal or over weight)
(obesity?) but would be around 2/3 of population so huge crisis if added to list
what are the 2 main sub-types of eating disorders?
anorexia and bulimia
characteristics of anorexia nervosa?
diagnostic criteria in DSM5?
4.
diagnostic issues in DSM4?
DSM5
1. refusal to maintain body weight (self-starvation) so at least 15% below normal weight
- restricting or binge/purge
- intense fear of weight gain (not reduced by weight loss)
- distorted body image
DSM4 amenorrhoea (loss of periods but taken out as doesn't happen to men and periods may stop for other reasons)
used to be BMI below 18.5 (drinking a litre of water will bring you above threshold as 1kg but not recovered)
characteristics of bulimia nervosa?
loss of control over eating (2 hours) and eat an excessive amount (binge) then purge (vomiting/laxatives/diet pills/exercising)
fear of gaining weight (same as anorexia)
effective treatments of anorexia nervosa?
¬ food - side effect of feeling terrible (short term treatment)
¬ family-based interventions (most effective)
structured family meals
meal plans
family therapy
¬ no NICE improved ‘first line’ treatment
¬ MANTRA manualised treatment for adults e.g meal management
effective treatment for bulimic nervosa?
CBT-E (extended form of CBT) seems to be effective
very Behavioural
sitting with person and helping them find a way to eat (let cognitive processes catch up)
20 or 40 session model (a lot)
effective treatment for Binge Eating Disorder?
not known what even causes binges so no knowledge of how to treat
what percentage of females aged 15 have issues with their body image?
and why do only a small % of those develop an eating disorder?
in 90s%
in western media based society
been getting worse especially due to social media
may be another risk factor than body dissatisfaction alone
have eating disorders always been with us cross-culturally or just western concept?
fiji before and after television (body dissatisfaction 35%-85%) due to introduction of psychosocial stressor (social cultural component)
bolder, colorado fitness based and so high level of eating disorders
if eating disorders genetic why have they been continually passed down in evolution?
adaptation to flea famine hypothesis - can operate on low body weight and think straight and lead rest of people to food and water sources (advantage)
what is orthorexia?
obessession with eating ‘healthy’ foods
not officially classified as an ED
what are OSFEDs and examples?
umbrella term for several disordered eating behaviours which don’t meet criteria for a specific eating disorder
e.g
body dysmorphic disorder
orthorexia
difference between DSM and ICD?
DSM5 american diagnostic system (apa) but UK increasingly using it (NICE guidance based on it)
just mental health, psychology and psychiatry
ICD10 all diseases not just mental health
international
difference between psychology and psychiatry?
psychology - broader view of human health and wellbeing
know more about psychology than medics
psychiatry - branch of medicine based on ‘ill-health’ and diseases
do medical degree first
do you need a diagnosis to get access to mental health treatment?
yes
risk factors at birth/infancy?
gender
genetics
feeding
parenting style
being female (different biologically and psychosocial pressures)
genetic in adolescence - 1st degree relative then 10x more likely to have AN and MZs higher concordance than DZs
early feeding difficulties (fussy)
high concern parenting - child never gets to experience hunger as so highly attuned to child
childhood risk factors?
childhood obesity - restricting and bulimic disorders
sexual abuse/neglect
OCPD - obessions around food
childhood anxiety disorders
risk factors in adolescence?
being an adolescent as when they tend to emerge
body dysmorphic disorder
high level exercise (jockeys, dancers, runners i.e any weight threshold)
dieting positively reinforced by sense of mastery and self-control
OCD/perfectionism
negative self-evaluation
what are the 5 factors clinicians look for to understand how to treat their patient with an ED?
predisposing factors precipitating factors presenting factors perpetuating factors protective factors
bio-psycho-social model as a cause of eating disorders
predisposing
precipitating
perpetuating
predisposing factors - epigenetics, genetics, brain and socio-cultural context which turns these factors into a vulnerability
precipitating factors - puberty (hormoal, social etc.), dieting and stress/trauma
perpetuating factors - management by parents and clinicians, trauma and stress, some perceived advantages so maintaining it e.g reduced stress when not eating
why may CBT not be the most effective treatment for eating disorders?
but how widely is it used
major cause could be due to neurobiological abnormalities causing different neuropsychological processing styles so not just the ‘here and now’ to treat
but CBT is the main form of psychological therpay for all the eating disorders and the most effective
what % do we know about the brain?
around 1%
neurobiological abnormalities?
abnormality persists even after recovery
left sided hypoperfusion (reduction in activity and blood flow) centered on insula which deals with hunger, body image and disgust
70% of patients have functional abnormality in insula network
if abnormality in brain due to starving the body, would expect reduced activity in all areas not just e.g insula
what is an example of a neuropsychologically informed treatment for eating disorders?
cognitive remediation therapy
not addressing what you think (processes) but how you think (content)
give homework to e.g try and be flexible at home and do something different
role of noradrenaline in eating behaviour?
positive and negative reinforcement
starving = shortage of noradrenaline which = decrease in stress levels SO reinforces the starving behaviour
nordrenaline receptors become supersensitive
SO when person eats, these receptors are flooded with noradrenaline = increase in stress levels = negatively reinforced
reinforces negative view of food side effect that it makes them feel terrible
relation between diet coke and those with eating disorders?
many drink it, presumed due to being ‘diet’
may be due to the fact it contains tyrasine, which contains dopamine, which contains nordadrenaline so person is unknowingly self-medicating
which 3 networks are the focus of medication?
norderenaline dopamine (reward network) seronergic network (depressive)
relationship between buddhist monks and the insula network?
as a result of meditating for 8 hours a day for 30 years, their insula networks are larger as they practice body mapping daily
what are buddhist monks and real time fMRIs examples of?
neurobiofeedback
what is real time fMRI?
showing or telling a person their current insula activation and asking them to make it higher/lower by changing blood flow to insula
if healthy can learn to modulate in about 5 mins even though they don’t know how
neuropsychological processing styles found in people with eating disorders:
issues with visual spatial processing
have problems with visual spatial processing
related to insula network
creates difference between how they see their body and how they feel about their body
neuropsychological processing styles found in people with eating disorders:
central coherence
inability to integrate global processing and detailed thinking
(seeing both the wood and the tree), only detailed thinking
neuropsychological processing styles found in people with eating disorders:
cognitive flexibility
problems with shifting between different ways of thinking so stuck in ritualistic thoughts
neuropsychological processing styles found in people with eating disorders:
risk / reward processing problems
ability to identify risky choices and avoid impulsive responses
impaired
neuropsychological processing styles found in people with eating disorders:
problems with emotion processing
issues in turning emotions into feelings
e.g
alexithymia - lacking words for feelings so makes psychotherapy difficult
what is formulation and what is the model that goes alongside it?
working out which risk factors may be relevant and organising thinking (clinician)
the 5 P model
the 5 P model
what are predisposing factors?
predisposing risk factors in infancy e.g genetics, epigenetics and socio-cultural environment
the 5 P model
what are precipitating factors?
what got the ED started e.g depressive episode or traumatic event or dieting
and when first aware that they had it
the 5 P model
what are presenting factors?
rich description of what’s going on and what it means to them e.g describe typical day
the 5 P model
what are perpetuating factors?
what’s maintaining the ED (often very different reason for why it started) and able to establish through presenting factors
deal with here and now
the 5 P model
what are protective factors?
what assets/social support have you got that can help you recover
need message of hope
why is it hard to treat prepubertal 8-10 year olds with AN?
they are unaware why they have the disorder as can’t articulate it
just that restrcting
works for them
typically, who does the public blame for eating disorders?
the person who has the disorder as sees them as deliberately ‘self-destructive’ and ‘attention-seeking’
what is the meaning behind ‘anorexia’ and ‘nervosa’?
anorexia - loss of appetite (but majority of people don’t actual lose their appetite)
nervosa - loss due to emotional reasons
what is the lifetime prevalence of anorexia and ratio of men to women with it?
less than 1%
10:1 to women
suicide rates for anorexia?
5% complete
20% attempt
what are the physical consequences of anorexia?
change in hormone levels
heart rate slows
blood pressure falls
what is the prognosis for those with anorexia?
between 50-70% recover but takes 6-7 years
mortality rates for women are 3-5% (due to suicide and physical complications due to illness)
prevalence of bulimia?
mortality rate?
around 1-2% of women
mortality rate nearly 4%
what are the physical consequences of bulimia?
amenorrhea
irregular heart rate
loss of enamel and tearing of stomach tissue due to vomiting
prognosis of bulimia?
75% recover
what are the characteristics of binge eating disorder?
what makes it distinct from both anorexia and bulimia?
recurrent binges -
once a week over 3 months to be diagnosed
distress over binges
lack of control during bingeing episodes
most often obese people (BMI<30)
not anorexia - no weight loss and not restrictive as lose control
not bulimia - no compensatory behaviours e.g vomiting
prevalence of binge eating disorder?
2% for men and 3.5% for women
physical consequences of binge eating disorder?
IBS
sleep problems
mood disorders
medication as a treatment for eating disorders
bulimia - treated with antidepressants as highly comorbid with depression
BUT high dropout due to side effects and high relapse rate when finish treatment
anorexia - not been successful in improving weight or anything else
family therapy as a treatment
interpersonal problem not individual problem
bring family conflict to the fore instead of avoiding it
helping eating disorder brings family closer
